Transcatheter mitRal valve rEpair early after acute Myocardial infArction and low outPut state: a troublesome liaison. A preliminary analysis from the REMAP registry.

Background: Acute secondary mitral regurgitation (SMR) complicated by low cardiac output state (LCOS) after an acute myocardial infarction (AMI) is associated with increased morbidity and mortality. Transcatheter mitral valve repair (TMVR) with MitraClip® system is a less invasive alternative to surgery which appears to be promising in high operative risk patients. However, its role in these specific setting remains poorly defined. Purpose: To assess baseline, echocardiographic and procedural characteristics of patients admitted for infarct related acute SMR complicated by LCOS or cardiogenic shock (CS) treated with the MitraClip® implantation, in order to identify ‘responders’ and to evaluate whether it represents a bridge to heart replacement therapies or recovery. Methods: In this preliminary analysis of the REMAP registry, we retrospectively collected data on 10 consecutive patients who underwent MitraClip® implantation for moderate to severe or severe acute SMR post-infarct at 3 italian centers between January 2014 and December 2019. As an all-comers initiative, exclusion criteria were minimal. Median follow-up period was 1 year. Primary endpoint was a composite of overall mortality, heart failure hospitalization, need for urgent heart replacement therapies, persistent inotropic/mechanical support dependence or urgent conversion to open heart surgery. Its single components were the secondary endpoints along with NYHA class ≤ II and MR grade ≤ 2+ during follow-up. Results: Discharge survival was 90%. 4 out of 5 patients had MR grade ≤ 2+ and a NHYA class ≤ II at 1-year of follow-up. Primary endpoint was 55.6 % and 87.5 % at 3-months and 1-year, respectively. 1-year overall mortality was 37.5 %; among survived patients, 3 were treated with long-term left ventricular assist device, one of whom subsequently underwent orthotopic heart transplantation. Conclusions: This preliminary analysis from the REMAP registry, shows how MitraClip® procedure in patients with infarct related acute SMR complicated by LCOS or CS should be used as a bridge to heart replacement therapies and not as a definitive treatment to achieve recovery